Dd Form 108 - Application For Retired Pay Benefits
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1
2See back for Instructions and
APPLICATION FOR RETIRED PAY BENEFITS
Privacy Act Statement.
1. TO
2. DATE OF BIRTH
3. DATE RETIRED PAY TO
(YYYYMMDD)
BEGIN
(YYYYMMDD)
HR CENTER OF EXCELLENCE
ATTN: AHRC-PDP-TR DEPT 482
4. HIGHEST MILITARY PAYGRADE HELD
1600 SPEARHEAD DIVISION AVE, FT. KNOX, KY 40122-5402
5. APPLICANT NAME
6a. SERVICE NUMBER
b. SOCIAL SECURITY NUMBER
(Last, First, Middle Initial)
(If applicable)
7a. PRESENT HOME ADDRESS
8. PRESENT ASSIGNMENT
(Street, Apt No., City, State, ZIP Code)
RETIRED RESERVE DATE:
(
)
b. HOME TELEPHONE NUMBER
SERVICE BEFORE 1 JULY 1949
11. APPROXIMATE DATES OF SERVICE
12. ACTIVE DUTY
9.
10.
ARMED FORCE
GRADE OR
a. FROM
b. TO
a. FROM
b. TO
AND COMPONENT
RATING
DAY
MONTH
YEAR
DAY
MONTH
YEAR
DAY
MONTH
YEAR
DAY
MONTH
YEAR
SERVICE AFTER 30 JUNE 1949
13. RETIREMENT YEAR
16. ACTIVE DUTY
14.
15.
17.
ARMED FORCE
GRADE OR
a. FROM
b. TO
a. FROM
b. TO
RETIREMENT
AND COMPONENT
RATING
POINTS EARNED
DAY
MONTH
YEAR
DAY
MONTH
YEAR
DAY
MONTH
YEAR
DAY
MONTH
YEAR
SEE ATTACHED
18. SIGNATURE
19. DATE SIGNED
(YYYYMMDD)
DD FORM 108, JUL 2002
PREVIOUS EDITION IS OBSOLETE.
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